Orthodontics/Endodontics Enhanced CPD DO C & DO D

Hamza Anwar

James Darcey and Ovais H Malik

The Orthodontic/Endodontic
Interface Part 4
Abstract: The final part of this four part series will review the effects of orthodontic treatment with endodontically treated teeth. There are
few published articles on the challenges faced when treatment planning cases with the integration of both endodontics and orthodontics.
This article will aim to summarize the implications of endodontic treatment on orthodontic tooth movement using current evidence,
followed by some case examples highlighting aspects of the orthodontic-endodontic interface.
CPD/Clinical Relevance: With an increase in the number of patients undergoing orthodontic treatment, there is a greater need for
clinicians to be aware of the orthodontic management of endodontically treated teeth and also managing endodontic complications
during orthodontic treatment.
Dent Update 2018; 45: 1024–1031

Orthodontic outcomes on the
vital tooth
More patients are undergoing
orthodontic treatment and mild external
root resorption is a common finding.1,2 This
is usually not clinically significant with a root
length reduction commonly of 1−2 mm.3
Severe root resorption in which more than
Hamza Anwar, BDS, MSc, MFDS RCS(Ed),
MOrth RCS(Eng), MOrth RCS(Ed), StR in
Orthodontics, University Dental Hospital
of Manchester, Higher Cambridge Street,
Manchester, M15 6HF, James Darcey,
BDS, MSc, MDPH, MFGDP
RCS(Eng), MEndo RCS(Ed), FDS Rest
Dent RCS(Ed), Consultant in Restorative
Dentistry, University Dental Hospital of
Manchester, Higher Cambridge Street,
Manchester, M15 6HF and Ovais H Malik,
BDS, MSc(Orth), MFDS RCS(Ed), MOrth
RCS(Eng), MOrth RCS(Ed), FDS(Orth)
RCS(Eng), Consultant in Orthodontics,
University of Manchester Dental Hospital,
Salford Royal NHS Foundation Trust and
Northenden House Orthodontics, Sale
Road, Manchester M23 0DF, UK.
1024 DentalUpdate December 2018
one quarter of the root length is lost has
been reported in 3% of orthodontic patients.4
The greatest amount of resorption is seen in
the anterior maxillary region, especially the
maxillary lateral incisors.5 The most significant
factors affecting root resorption appear to be
the duration of orthodontic treatment and the
distance that teeth are moved.6
As the stimulus to this process is
the orthodontic forces and these are time-
limited and finite, the extent of resorption is
usually minimal and healing will follow. This
is not regeneration but rather reformation of
the cementum and periodontal ligament on a
modified and invariably blunted root surface.
Nonetheless, teeth with a history of trauma
or deep restorations present with other risk
factors for root resorption that may not be
controlled by the cessation of orthodontic
forces. As such, it is sensible to take peri-apical
radiographs beforehand and apply more
gentle forces in these high risk cases.
Root resorption
Resorption has been defined
as a condition associated with either a
physiological or a pathologic loss of dentine
through the continued action of osteoblasts.7
Several distinct categories of resorption occur
Downloaded from magonlinelibrary.com by 156.062.003.011 on January 28, 2019.
(Table 1):
1. Internal Root Resorption: A process of
up-regulation of osteoclasts within the
pulp canal system which results in dentinal
removal and enlargement of the canal space.
The stimulus could be anything resulting in
inflammation within the pulp.
2. External Surface Resorption: This is a self-
limiting process.8 This occurs as a result of
removal of damaged periodontal ligament
tissues by macrophages and osteoclasts. It
usually affects small areas of the root surface
and is followed by spontaneous repair from
adjacent parts of the periodontal ligament in
the form of new cementum.
3. External Inflammatory Resorption: This is a
consequence of up-regulation of osteoclasts
on the external aspect of the root following an
intense inflammatory insult. This is most often
found following trauma where there is both
damage to the root surface and necrosis of
the pulp. In these cases bacteria and bacterial
lipopolysaccharides can pass through the
dentine and directly stimulate osteoclastic
activity. If the stimulation is not controlled
this can result in significant destruction of
cementum and dentine.
4. External Cervical Resorption: This condition
remains poorly understood but there is very
 Orthodontics/Endodontics

localized up-regulation of osteoclasts in Internal Resorption External External External

response to some stimulus in the cervical Resorption: Resorption: Resorption:
region. It has been associated with bleaching, Surface Resorption Inflammatory Replacement
trauma and orthodontic treatment. The Resorption Resorption
osteoclasts enter the dentine and progress
into the tooth structure apically and Rare, but usually Associated with Associated with Associated with loss
coronally.9,10 The cementum and periodontal associated with trauma or damage injury to the of vitality of the PDL
ligament prevent the lesion perforating infected/necrotic to cementum periodontal
externally and the predentine prevents the pulp ligament (PDL)
lesion perforating the pulp.As such the tooth Resorptive process May be transient or Communication Tooth structure
will often appear like an apple core and, if left requiring vital tissue progressive with dentinal is replaced with
untreated, is liable to pathological fracture. tubules following alveolar bone fused
5. Replacement Resorption: This is a surface resorption to dentine
physiological process whereby bone replaces
tooth structures, leading to ankylosis. This is Clinically detectable Mild, affecting small Can lead to necrosis Clinically detectable
a dynamic process, which occurs following due to discoloration areas of root surface with dull percussion
significant damage to the protective of tooth
periodontal ligament and cementum Can be detected Usually not detected Usually can be Difficult to detect
surrounding the root surface of a tooth. It on plain film on radiographs detected on plain on plain film
results from a disturbance in the activity of radiographs film radiographs radiographs
cementoblasts and odontoblasts in the area depending on size
of damage. of lesion
The earliest sign of replacement Table 1. Summary of the main types of root resorption.
root resorption tends to be a dull percussion
note which can be detected once 20% of
the root surface is affected by replacement
resorption.11 This can lead to ankylosis resorption was compared to the contra-lateral canal filling material.19
and commonly occurs on the buccal and vital control tooth and it was shown that there If the root canal treatment is
palatal root surfaces, which can lead to the was no statistically significant difference in the adequately condensed laterally, then the
process not being detectable on plain film amount of apical root resorption amongst vital resorptive process should not affect the apical
radiographs for up to a year. and root-filled teeth.18 seal of the tooth.
Therefore, from the available It has been outlined by the
Orthodontic management of evidence, it can be concluded that there European Society of Endodontology that
root-filled teeth is no difference in the root resorption of endodontic treatment can be considered a
There have been many conflicting endodontically treated teeth when compared to success one year post-obturation when there
reports on the impact of orthodontic tooth vital teeth that are subjected to the same force. is absence of pain or swelling, no sinus tract,
movement on endodontically treated teeth. There has been little investigation no loss of function and radiographic signs of
Some authors have reported increased risks into the remaining root canal filling material a normal periodontal ligament space around
and rates of root resorption, whilst others following external root resorption of an the tooth.20
have reported equal or reduced risks.12-16 endodontically treated tooth. Many possibilities
Animal studies have often been exist:
 It is possible that the root filling material may Treatment approach
used when researching the orthodontic tooth
movement in both vital and non-vital teeth. be removed along with the tooth during this when endodontically treating
These have shown that, in both cases, teeth process; teeth undergoing orthodontic
moved similar distances when subjected to  It could also be the case that the tooth treatment
the same forces.17 Histologically, it was shown resorbs, with the filling material being left in the There has been much debate
that root-filled teeth showed greater loss of alveolar bone. This could lead to fibrous tissue regarding the obturation material of
cementum compared to vital teeth. However, surrounding the filling material or even a sinus choice when endodontically treating teeth
more importantly, there was no significant tract developing; undergoing orthodontic treatment. The
difference in root length.  In some cases, it may be such that the initial approach was to dress the affected
A more recent retrospective resorptive process leads to some of the filling tooth with non-setting calcium hydroxide
study was undertaken to investigate the material protruding beyond the new apical during orthodontic tooth movement.21 Once
radiographic findings of root resorption foramen of the tooth. In this situation, it is often orthodontic treatment was completed,
amongst patients undergoing orthodontic seen that a new periodontal ligament space the root canal(s) would subsequently be
treatment who had one maxillary incisor and lamina dura develop around the apex of obturated with gutta percha. However, animal
which was root-filled. The amount of root the tooth in close approximation with the root studies have shown that teeth obturated with
December 2018 DentalUpdate 1025
Downloaded from magonlinelibrary.com by 156.062.003.011 on January 28, 2019.
 Orthodontics/Endodontics
gutta percha are at no increased risk of
resorption during orthodontic treatment.22
Therefore, a definitively obturated tooth
with an adequate coronal seal is at no
increased risk of resorption compared to
that dressed with calcium hydroxide during
orthodontic tooth movement.
Teeth dressed with calcium
hydroxide have an increased risk of
fracture, with the dentine fracture
resistance strength reduced by 44% 84
days after placement of the dressing.23
This evidence would further support the
recommendation of completing the root
canal treatment, definitively obturating the
tooth and providing a coronal seal prior to
commencing orthodontic tooth movement.
An exception to this
recommendation would be teeth that show
signs of external inflammatory resorption
during treatment. Placement of a calcium
hydroxide dressing for up to 12-weeks prior
to obturation has been shown to have a
significant difference in promoting root
healing with new cementum.24
Observation period post-
endodontic treatment
There is limited evidence
available as to the recommended
observation periods post-endodontic
treatment, before commencing orthodontic
tooth movement. Guidance is often based
on expert opinions. Animal studies have
shown that orthodontic forces applied to
endodontically treated teeth delay the
peri-apical healing process but do not
prevent this process from occurring.25 It
has been suggested that, in cases where
root canal treatment has been undertaken
due to pulpal necrosis secondary to caries,
orthodontic tooth movement can be
commenced immediately post obturation.26
Where there have been areas of extensive
bone loss, orthodontic tooth movement
should be delayed until there are
radiographic signs of healing and a minimal
interval of 6-months has been suggested.
Following dental trauma, an observation
period of 12 months has been suggested
prior to commencing tooth movement in
order to decrease the risk of ankylosis. It has
been shown that even a 12-month delay
cannot always stop ankylosis from occurring
and thus patients should always be warned
of this possibility.27
1026 DentalUpdate December 2018
Orthodontic management and
dental trauma during treatment
If a patient suffers dental trauma
undertaking orthodontic treatment, some
protection may be offered by the stabilizing
effect of the orthodontic appliance itself.
However, the management is dependent on
the type and severity of the injury.
Types of injuries
Intrusion injuries
Intrusion injuries can often
be difficult to manage due to effects on
the pulpal tissues, periodontal ligament
and alveolar bone. They account for 1.7%
of traumatic injuries.28 Mild intrusion
injuries can often lead to spontaneous
regeneration of the periodontal ligament.
Thus for mild intrusion injuries in teeth with
closed apices, it has been recommended
to allow a 2-week period for spontaneous
re-eruption.29 Moderate and severe injuries
require interdisciplinary management. With
the increased severity of the intrusion injury,
there is a greater risk of pulpal necrosis and
the possibility of replacement resorption
occurring, as described above. There are
further risks including loss of alveolar bone
and infraocclusion.
It has been recommended by
the Dental Trauma Guide that orthodontic
repositioning may be appropriate when a
tooth has been intruded by 3-7 mm. Any
intrusion greater than this would indicate
surgical repositioning. Simply put, the tooth
may not even be visible to bond a bracket to!
It may be necessary to apply gentle luxation
forces prior to orthodontic repositioning in
cases where the tooth has become locked in
the alveolar bone. This should be promptly
followed by extirpation and root canal
treatment to prevent inflammatory resorption
from occurring. Endodontic treatment should
be initiated immediately on all teeth with
avulsion or intrusion injuries. This is due to the
higher prevalence of root resorption reported
in severe intrusion injuries in teeth with
closed apices.30
Animal studies have shown
that inducing light occlusal stimuli can
promote periodontal healing and prevent
replacement resorption from occurring. In
a study undertaken on mice, it was shown
that, with heavier occlusal stimuli, there
was an increased risk of root resorption.31
This indicates that placement of a light
Downloaded from magonlinelibrary.com by 156.062.003.011 on January 28, 2019.
aligning orthodontic wire to reposition teeth
may reduce the risks of ankylosis and root
resorption following an intrusion injury. An
example of management of intrusion injuries
is demonstrated in Case 2.
Extrusion injuries
Extrusion injuries are less
common. Mostly, these can be treated by
cleaning the exposed root surface with saline
prior to repositioning the tooth with gentle
axial pressure. This is followed by stabilizing
the tooth with a flexible splint for 2 weeks.32
However, in cases where there is a large
extrusive displacement, the prognosis of the
tooth is reduced.Orthodontic alignment at an
early stage may be required to align the tooth
prior to any root resorption occurring. This is
followed by endodontic treatment to prevent
internal resorption. This process is highlighted
in Case 3.
Root fractures
Root fractures have an incidence
of 0.5−7%.33 They present as complete
or incomplete, and horizontal or vertical
fractures. In the majority of root fractures the
apical fragment of tooth remains vital. The
aim of treatment is to attempt to preserve
the vitality of the coronal fragment of the
tooth and an extended period of splinting is
required to promote a hard tissue of dental
callus between the two fragments. If any
orthodontic tooth movement is required,
it is essential that the presence of this hard
tissue barrier is radiographically confirmed.34
If, however, the tooth has healed with a
connective tissue barrier between the
fragments, the tooth has to be considered
as having a short root. Provisions need to
be undertaken to prevent any further apical
root resorption and thus light orthodontic
forces are advocated. When there are signs
of granulation tissue between the two
fragments, following necrosis of the coronal
fragment, then endodontic treatment
is required prior to orthodontic tooth
movement. An observation period of 1−2
years has been suggested prior to orthodontic
tooth movement following root fracture.27
Avulsions
Avulsion injuries account for
1−6% of all dental trauma injuries.8 It is
well reported that the outcome of such
injuries is poor unless they are stored in a
 Orthodontics/Endodontics

a a b

d e

Figure 2. (a–e) Case 2: Pre-treatment views of a patient following dental trauma to the maxillary
incisors involving intrusion of UR1 and UL2.

d
Figure 1. (a–d) Case 1: Treatment of
inflammatory root resorption.
December 2018 DentalUpdate 1027
physiologic medium, such as milk or saliva, re-implantation. Thus avulsed teeth with a
and subsequently re-implanted immediately. closed apex should be treated endodontically
Thus avulsion injuries often lead to pulpal and be kept under review to ensure that
necrosis and have a poor long-term prognosis. there is no subsequent resorption prior to
In cases of delayed re-implantation, ankylosis attempting any orthodontic tooth movement.
is unavoidable. Removal of necrotic pulp and
endodontic treatment will minimize the risk Ankylosis
of root resorption and ankylosis following As outlined in Table 1, loss of
Downloaded from magonlinelibrary.com by 156.062.003.011 on January 28, 2019.
 Orthodontics/Endodontics

a a

b c

Figure 4. (a–c) Case 3: Management of an extrusion injury to UL1 in a patient undergoing orthodontic
treatment.
d

vitality of the periodontal ligament due to to commencing orthodontic tooth movement.

trauma can lead to replacement resorption
and ankylosis of a tooth. Ankylosed Case studies
teeth cannot be moved with orthodontic
Three short case studies have
appliances. This can provide a range of options
been summarized, highlighting patients
to manage the tooth, including accepting the
requiring endodontic intervention post-
position and allowing restorative correction
orthodontic treatment.
at the end of orthodontic treatment or loss
of the ankylosed unit. Ankylosed teeth can Case 1
often be used to reinforce anchorage during This case demonstrates a 16-year-
orthodontic treatment. There have been old female who presented with inflammatory
many case reports involving luxation of root resorption affecting UR3 following
the ankylosed tooth and subsequent tooth completion of orthodontic treatment with
movement has been successful. Luxation fixed appliances. As discussed above, external
of the ankylosed tooth can lead to pulpal root resorption is a known risk of orthodontic
Figure 3. (a–d) Case 2: Post-orthodontic
necrosis and thus endodontic treatment is treatment. Although it is not the primary
treatment to align intruded UR1 and UL2.
required to remove necrotic pulpal tissue prior focus of this paper to discuss the endodontic
1028 DentalUpdate December 2018
Downloaded from magonlinelibrary.com by 156.062.003.011 on January 28, 2019.
 Orthodontics/Endodontics

December 2018 DentalUpdate 1029

Downloaded from magonlinelibrary.com by 156.062.003.011 on January 28, 2019.
 Orthodontics/Endodontics
management of resorption, a brief overview
of treatment can be seen in Figure 1. The
extent of the lesion can be seen in the CBCT
image in Figure 1a. Endodontic management
was undertaken using techniques outlined in
previous literature.35 To summarize, initially this
involved conventional obturation with gutta
percha (Figure 1b). This was followed by surgical
access of the lesion, with curettage to allow
direct removal of osteoclastic cells (Figure 1c).
Finally, a definitive restoration with Biodentine®
(Septodont, Maidstone, UK) was placed over
the affected lesion (Figure 1d). This treatment
approach stabilized the resorptive lesion and,
on follow-up, no further resorption was noted.
Case 2
A 14-year-old patient was referred
by his GDP for an orthodontic assessment,
following trauma to all upper incisor teeth.
UR1 was avulsed and re-implanted at a local
hospital. UR1 and UL2 were also intruded
relative to UL1 (Figure 2). An OPG and peri-
apical radiographs were taken (Figure 2c−e)
which showed radiographic signs of internal
and external root resorption affecting UL1; the
long-term prognosis of this tooth was deemed
to be very poor. The patient was informed
regarding the poor prognosis of all upper
incisor teeth and, in particular, about the high
possibility of ankylosis of UR1 and UL2. In
addition, he also presented with large carious
lesions in all his first permanent molars.
Orthodontic treatment was
outlined with upper and lower fixed appliances
in an attempt to align the intruded upper
incisors. This would also help to determine the
possibility of ankylosis of the affected teeth.
If the teeth were to respond to orthodontic
alignment, the patient would need possible
endodontic treatment of UR1 and UL2 to
prevent any internal resorption in the long term.
The patient was warned about the possibility of
implant replacement of all upper incisors at the
end of orthodontic treatment.
End of treatment views (Figures 3a
and b) show all the upper incisors were aligned
with orthodontic treatment. However, the peri-
apical radiographs taken during orthodontic
treatment (Figures 3c and d) show all upper
incisors had suffered from varying degrees
of root resorption, with UL1 and UR1 roots
indicating a poor long-term prognosis. After a
joint consultation with the restorative dentist, a
treatment plan involving implant replacement
of UR1 and UL1 and endodontic treatment on
1030 DentalUpdate December 2018
UR2 and UL2 was formulated.
This case demonstrates the high risk
of inflammatory and replacement resorption 3. Kennedy DB, Joondeph DR, Osterberg SK, Little RM.
following intrusion injuries and the difficulties
in managing such complications. Furthermore,
it highlights the interdisciplinary management
required between orthodontics, endodontics 4. Sameshima GT, Sinclair PM. Characteristics of
and restorative dentistry when aiming to
achieve optimal aesthetics and function.
Case 3
A 17-year-old patient presented
following trauma to UL1. The patient was in
active orthodontic alignment treatment with
upper and lower fixed appliances. UL1 was
significantly extruded (Figure 4a). The tooth
was gently intruded back into its correct
position. It can be seen from the peri-apical
radiograph (Figure 4b) taken after intrusion of
the tooth that there was apical root resorption
in the region of 2−3 mm. Towards the end of
orthodontic treatment, there were clinical signs
of pulpal necrosis and thus, to prevent any
further root resorption, the tooth was treated
endodontically and obturated with GP following
debond of the orthodontic appliances (Figure
4c). This case highlights the risks of extrusion
injuries and the combined need for orthodontic
intrusion and endodontic treatment to manage
such complications.
Conclusion
The interrelations of pulpal
health, osteoclastic activity and orthodontic
treatment are complex and poorly understood.
All patients should be consented to some
reduction in root length following orthodontic
treatment but some require greater care
and observation. When disease is present,
endodontic treatment should be undertaken
in advance of orthodontic treatment and these
teeth monitored closely for healing and signs
of resorption. Practitioners should, however,
feel confident that endodontic treatment itself
should have no impact on the outcomes of the
orthodontic treatment, Cases presenting with
trauma mid-orthodontic treatment should be
managed more conservatively; orthodontic
treatment should be stopped and all pathology
controlled before recommencing care.
References
1. Scott P, Fleming P, DiBiase A. An update in adult
orthodontics. Dent Update 2007; 34: 427−436.
2. Brezniak N, Wasserstein A. Root resorption after
Downloaded from magonlinelibrary.com by 156.062.003.011 on January 28, 2019.
orthodontic treatment: Part 2. Literature review. Am
J Orthod Dentofacial Orthop 1993; 103: 138−146.
The effect of extraction and orthodontic treatment
on dentoalveolar support. Am J Orthod 1983; 84:
183−190.
patients with severe root resorption. Orthod
Craniofac Res 2004; 7: 108−114.
5. Linge L, Linge BO. Patient characteristics and
treatment variables associated with apical root
resorption during orthodontic treatment. Am J
Orthod Dentofacial Orthop 1991; 99: 35−43.
6. Segal GR, Schiffman PH, Tuncay OC. Meta analysis of
the treatment-related factors of external apical root
resorption. Orthod Craniofac Res 2004; 7: 71−78.
7. Patel S, Kanagasingam S, Pitt Ford T. External
cervical resorption: a review. 
J Endod 2009; 35: 616–625
8. Andreasen JO, Andreasen FM. Textbook and Color
Atlas of Traumatic Injuries to the Teeth 3rd edn.
Copenhagen: Munksgaard, 1994.
9. Darcey J, Qualtrough A. Resorption: part 1.
Pathology, classifcation and aetiology.
Br Dent J 2013; 214: 439–451.
10. Patel S, Mavridou AM, Lambrechts P, Saberi
N. External cervical resorption‐part 1:
histopathology, distribution and presentation. Int
Endod J 2018; 51: 1205–1223.
11. Brezniak N, Wasserstein A. Orthodontically induced
inflammatory root resorption. Part I: the basic
science aspects. Angle Orthod 2002; 72: 175−179.
12. Levander E, Malmgren O, Stenback K. Apical root
resorption during orthodontic treatment of patients
with multiple aplasia: a study of maxillary incisors.
Eur J Orthod 1998; 20: 427−434.
13. Wickwire NA, McNeil MH, Norton LA, Duell RC. The
effects of tooth movement upon endodontically
treated teeth. Angle Orthod 1974; 44: 235−242.
14. Hunter ML, Hunter B, KingdonA, Addy M, Dummer
PM, Shaw WC. Traumatic injury to maxillary incisor
teeth in a group of South Wales school children.
Endod Dent Traumatol 1990; 6: 260−264.
15. Spurrier SW, Hall SH, Joondeph DR, Shapiro PA,
Reidel RA. A comparison of apical root resorption
during orthodontic treatment in endodontically
treated and vital teeth. Am J Orthod Dentofacial
Orthop 1990; 97: 130−134.
16. Remington DN, Joondeph DR, Artun J, Riedel
RA, Chapko MK. Long-term evaluation of root
resorption occurring during orthodontic treatment.
Am J Orthod Dentofacial Orthop 1989; 96: 43−46.
17. Mah R, Holland GR, Pehowich E. Periapical changes
after orthodontic movement of root-filled ferret
canines. J Endod 1996; 22: 298−303.
18. Esteves T, Ramos AL, Pereira CM, Hidalgo MM.
Orthodontic root resorption of endodontically
 Orthodontics/Endodontics

treated teeth. J Endod 2007; 33: 119−122.
19. Hamilton RS, Gutmann JL. Endodontic-orthodontic
relationships: a review of integrated treatment
planning challenges.
Int Endod J 1999; 32: 343−360.
20. European Society of Endodontics. Consensus report
of the European Society of Endodontology on quality
guidelines for endodontic treatment.
Int Endod J 1994; 27: 115−124.
21. Dumsha T, Hovland EJ. Evaluation of long-term
calcium hydroxide treatment in avulsed teeth − an in
vivo study. Int Endod J 1995; 28: 7−11.
22. Cvek M. Prognosis of luxated non-vital maxillary
incisors treated with calcium hydroxide and filled
with gutta-percha. A retrospective clinical study.
Endod Dent Traumatol 1992; 8: 45−55.
23. Andreasen JO, Farik B, Munksgaard EC. Long-term
calcium hydroxide as a root canal dressing may
increase risk of root fracture. Dent Traumatol 2002;
18: 134−137.
24. Trope M, Moshonov J, Nissan R, Buxt P, Yesilsoy C.
Short vs. long-term calcium hydroxide treatment
of established inflammatory root resorption in
replanted dog teeth. Endod Dent Traumatol 1995; 11:
124−128.
25. De Souza RS, Gandini LG Jr, de Souza V, Holland
R, Dezan E Jr. Influence of orthodontic dental
movement on the healing process of teeth with
periapical lesions. J Endod 2006; 32: 115−119.
26. Kindelan SA, Day PF, Kindelan J, Spencer J, Duggal
MS. Dental trauma: an overview of its influence on
the management of orthodontic treatment: part 1.
J Orthod 2008; 35: 68−78
27. Malmgren O, Malmgren B, Goldson L. Orthodontic
management of the traumatised dentition. In:
Textbook and Color Atlas of Traumatic Injuries to
the Teeth 4th edn. Andreasen JO, Andreasen FM,
Andersson L, eds. Oxford: Blackwell Munksgaard,
2007: pp669−715.
28. Andreasen JO, Bakland LK, Matras RC, Andreasen
FM. Traumatic intrusion of permanent teeth.
Part 1: an epidemiological study of 216 intruded
permanent teeth. Dent Traumatol 2006; 22: 8−89.
29. Flores MT, Andersson L, Andreasen JO et al.
Guidelines for the management of traumatic dental
injuries. I. Fractures and luxations of permanent
teeth.
Dent Traumatol 2007; 23: 66−71.
30. Costopoulos G, Nanda R. An evaluation of root
resorption incident to orthodontic intrusion. Am J
Orthod Dentofacial Orthop 1996; 109: 543−548.
31. Mine K, Kanno Z, Muramoto T, Soma K. Occlusal
forces promote periodontal healing of transplanted
teeth and prevent dentoalveolar ankylosis: an
experimental study in rats.
Angle Orthod 2005; 75: 637−644.
32. DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny
DJ, Trope M. International Association of Dental
Traumatology guidelines for the management of
traumatic dental injuries: 1. Fractures and luxations
of permanent teeth.
Dent Traumatol 2012; 28: 2−12.
33. Andreasen FM, Andreasen JO. Root fractures. In:
Textbook and Color Atlas of Traumatic Injuries to
the Teeth 4th edn. Andreasen JO, Andreasen FM,
Andersson L, eds. Oxford: Blackwell Munksgaard,
2007: pp337−371.
34. Zachrisson BU, Jacobsen I. Response to orthodontic
movement of anterior teeth with root fractures.
Trans Eur Orthod Soc 1974; 50: 207−214.
35. Darcey J, Qualtrough A. Resorption: part 2.
Diagnosis and management.
Br Dent J 2013; 214: 493−509.

For a more
rewarding
Trusted sales advice and local
knowledge from the dental
practice specialists
experience all round

E D
A LU Christie & Co was
V
After a wasted 12 months
amazing from the start
with an Agent with whom the – the service I received was
buyer pays their fees, I moved to so personalised to my needs,
Christie & Co. A very efficient and that unlike other agents who I
professional service. This has been had used before, I was completely
a fair deal for our patients, staff, buyer confident that they understood
and seller. A quick sale me, my practice, and had my best
and stress free at that. interests at heart.
Joe Ljustina Rana Al-Falaki,
ED
A-One Dental Care Al-FaPerio Ltd
ND
FU

Find out how we can help you too 020 7227 0700

christie.com

December 2018 DentalUpdate 1031

Downloaded from magonlinelibrary.com by 156.062.003.011 on January 28, 2019.